Sonography and Color Doppler in the Evaluation of Cold Thyroid Nodules

Background/ Thyroid nodules are a common finding, especially in our country. In this study, we evaluated the role of conventional ultrasonography (US) and color doppler sonography (CDS) in assessment of cold thyroid nodules. Ninety-seven patients with a cold thyroid nodule were examined by US and CDS before thyroidectomy. On US, the presence of a halo sign, hypoechogenicity or microcalcification was evaluated. The vascular pattern on CDS was classified as follows: Type 1, absence of blood flow; Type 2, perinodular blood flow; Type 3, intranodular blood flow. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasound and color doppler findings were evaluated. Ultrasound findings have been compared with postoperative pathological result. In 38 patients, thyroidal carcinoma was found. Absence of halo sign, presence of microcalcification and hypoechogenicity were predictive of malignancy (P < 0.001). Presence of intranodular hyper-vascularity and perinodular hypervascularity were in favor of malignancy (P < 0.001) and benignity (P < 0.01), respectively. An avascular pattern could not differentiate between benign and malignant nodules. US and CDS findings can predict malignant nodules, especially when multiple signs are simultaneously present.